Response of a GH- and TSH-secreting pituitary adenoma to a somatostatin analogue (SMS 201-995): evidence that GH and TSH coexist in the same cell and secretory granules.
Response of a GH- and TSH-secreting pituitary adenoma to a somatostatin analogue (SMS 201-995): evidence that GH and TSH coexist in the same cell and secretory granules.
复制标题
分泌 GH 和 TSH 的垂体腺瘤对生长抑素类似物的反应 (SMS 201-995)：证据表明 GH 和 TSH 共存于同一细胞和分泌颗粒中。
DOI：
10.1159/000125127
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发表时间：
1989
影响因子：
4.1
通讯作者：
O'Dorisio,TM
中科院分区：
文献类型：
--
作者：
Malarkey,WB;Kovacs,K;O'Dorisio,TM
一个29岁的男性表现为肢端肥大症和甲状腺功能亢进，被发现是高分泌GH和TSH。一种生长抑素类似物，SMS 201-995，每天3次，剂量分别为50和100µg s.c，可使血清GH和TSH水平急剧下降，低于基础浓度的20%。血清SMS 201-995水平的升高先于血清GH和TSH水平的下降。与生长激素过量相关的体征和症状部分消退，患者血清甲状腺素水平恢复正常。后一种效果在SMS 201-995治疗的3.5个月期间保持不变；然而，通过MRI判断垂体腺瘤的大小没有变化。治疗的副作用很小，包括短暂的腹痛、腹泻和体重增加。手术切除垂体腺瘤组织，置于单层培养。观察到SMS 201-995对GH和TSH的释放有明显的抑制作用。组织学显示部分嗜色性，部分嗜酸性腺瘤，含有生长激素和TSH。电镜显示垂体腺瘤由类似生长激素的小细胞和具有甲状腺激素超微结构特征的大细胞组成。免疫电镜将这两种生物化学上不同的肽定位在相同的细胞类型中，通常在相同的分泌颗粒中。未见因服用SMS 201-995所致的形态学异常。由此可见，垂体腺瘤可同时分泌促甲状腺激素和促甲状腺激素，导致肢端肥大症和甲状腺功能亢进。这些双激素肿瘤可能在同一种细胞类型中合成GH和TSH。施用SMS 201-995可抑制GH和TSH的分泌，对肢端肥大症和甲亢的临床和生化有显著改善。SMS 201-995对GH和TSH释放的抑制并不一定会导致肿瘤缩小和腺瘤细胞的形态异常。
A 29-year-old male presented with acromegaly and hyperthyroidism and was found to be hypersecreting both GH and TSH. A somatostatin analogue, SMS 201-995, at doses of 50 and 100 µg s.c. 3 times a day produced an acute decrease in serum GH and TSH levels to less than 20% of basal concentrations. An increase in serum SMS 201-995 levels preceded the decline in serum GH and TSH levels. Partial resolution of signs and symptoms related to GH excess occurred and the patient developed normal serum thyroxine levels. These latter effects were maintained during the 3.5 months of SMS 201-995 therapy; however, pituitary adenoma size as judged by MRI was unchanged. Side effects of therapy were minimal and included transient abdominal pain, diarrhea and weight gain. Adenomatous pituitary tissue was surgically removed and placed in monolayer culture. It was observed that SMS 201-995 produced significant inhibition of GH and TSH release. Histology revealed a partly chromophobic, partly acidophilic adenoma containing GH and TSH. Electron microscopy showed a pituitary adenoma which appeared to consist of smaller cells resembling somatotrophs and larger cells exhibiting ultrastructural features of thyrotrophs. Immunoelectron microscopy localized the two biochemically distinct peptides in the same cell type, often in the same secretory granules. No morphologic abnormality, attributable to SMS 201-995 medication, was evident. Thus it can be concluded that pituitary adenomas can simultaneously secrete GH and TSH which produce acromegaly and hyperthyroidism. These bi-hormonal tumors may synthesize GH and TSH in the same cell type. Administration of SMS 201-995 can inhibit the secretion of both GH and TSH, causing significant clinical and biochemical improvement of acromegaly and hyperthyroidism. Suppression of GH and TSH release by SMS 201-995 is not necessarily followed by tumor shrinkage and morphologic abnormalities in the adenoma cells.